FLEXIBLE SPENDING ACCOUNT ELIGIBLE EXPENSES
Unreimbursed Medical Expenses The Unreimbursed Medical Account is designed to help pay health care expenses incurred by you, your spouse, or your dependents, which have not and will not be reimbursed by any medical or dental insurance. Health care includes the prevention, diagnosis, treatment and care of physical or mental defect, illness or disease. Summary of Qualifying Unreimbursed Medical Expenses (Only eligible expenses not reimbursed by insurance can be claimed)
for alleviating illness !Ambulance hire !Artificial limbs and teeth !Automobile modifications (hand controls, special equipment, mechanical lifts) !Braille books & magazines ! Crutches !Drugs (legal) Rx’s only or insulin and Medical Supplies !Eyeglasses !Fees: Acupuncture Anesthetist Blood donor Chiropodist Chiropractor Christian Science Practitioners
!Air conditioning used
Clinic Dentist Diagnosis Diathermy Doctor examination physical Eye examination Gynecologist Hospital Laboratory Lip reading lesson for the deaf Midwife Nurse Obstetrician Oculist Operation Ophthalmologist Optician Optometrist Oral Surgery Osteopath
Pediatrician Physician Physiotherapist Podiatrist Practical Nurse Psychiatrist Psychoanalyst Psychologist Psychopathist Sanitarium Sex therapist Specialist Surgeon Therapy Weight loss problem (where prescribed as Treatment for specific disease) !Over the counter drugs for a medical condition !Rental of medical or healing equipment
!Food & beverages
(special) !Halfway house residency !Health Spa in home (to extent value of home not increased) !Hearing device !Hospital bills !Iron lung, operating cost !Laetrile, when prescribed by doctor !Lifetime care at medical facility !Membership in cooperative health association !Nursing care !Obstetrical expense !Operations & related treatments !Oxygen equipment
!Seeing-eye dog !Special education !Special television set
that provides deaf individuals with display of audio portion of television programs !Speech therapy !Support or corrective devices (including special mattress and board for arthritis) !Swimming Pool !Telephone for deaf !Therapy treatments treatments !Transportation expense relative to illness !Wheelchair or autoette (cost of operating and maintaining) !X-rays
Types of expenses not covered under the Unreimbursed Medical Account: 1. Any medical related expenses compensated by an insurance carrier. 2. The costs of over the counter drugs for general well being (i.e.vitamins). 3. Any expense not substantiated by a written statement from the service provider. 4. Cost of toiletries, cosmetics, and sundry items (e.g., soap, toothbrushes). 5. Physical treatments unrelated to a specific health problem. Dependent Care Expenses* Dependent care expenses are expenses incurred to enable you to work. If you are married, and your spouse is not a fulltime student and/or is capable of self-care, the expenses must be to enable you and your spouse to work. Any type of dependent care eligible for a federal income tax credit is eligible for reimbursement under the Dependent Care Expense Flexible Spending Account. Eligible Expenses Expenses may be reimbursed for any dependent who is under age 13 and for whom a personal exemption deduction is allowed for federal income tax purposes, the care of your dependent or spouse who is physically or mentally incapable of self-care, or household services in connection with the care of such a person. Expenses may be reimbursed for services provided 1. by a child care center, babysitter, or nurse. 2. outside your home for the care of your dependent or spouse. If the care is for a dependent who is age 13 or over or for your spouse and the dependent or spouse is incapable of self-care, the dependent or spouse must spend at least 8 hours a day in your home to qualify for dependent care reimbursement. 3. a nursery school, even though the school provides lunch and educational services. No amounts of educational services are eligible in the first grade or higher. 4. by a housekeeper whose services include, in part, providing care of an eligible dependent. 5. by a relative who provides dependent care services, if the relative is not your dependent or your spouse's dependent for whom a personal exemption deduction is allowed for federal income tax purposes, and is not your child or stepchild who is under age 19 at the end of the year. Types of expenses not covered under the Dependent Care Account: ! cost of food, clothing and education. ! cost of transportation between your house and the place where dependent care services are provided. ! cost of a child care center that provides care for more than six nonresidents, and which does not comply with all applicable laws. ! expenses for which a dependent care tax credit is taken.
*Maximum amounts that can be reimbursed: Married filing single return, lesser of $2,500 or your earned income. Married, filing jointly, lesser of $5,000 or earned income. Spouse, full-time student or incapable of self-care, spouse's income must be less than $200 per month for one eligible dependent or less than $400 per month for two or more eligible dependents. Single return, the lesser of $5,000 or your earned income.